Will I Ever Fix My Hamstrings?

I am plagued with hamstring tendinosis in both hamstrings, a condition I developed after training for the NYC marathon last year. I know exactly why it happened: I went from 30 to 70 miles miles a week in the span of two weeks and trained like that for 14 weeks. I've been to sports med doctors and had an MRI on both hamstrings which is when I was diagnosed. I can no longer do physical therapy, where I was getting ultrasound, heat, ice, and exercises, because my insurance no longer covers my sessions. I can do some of the exercises and ice on my own, but not the ultrasound, nor do I have the expertise of a PT any longer. Do you have any advice? Is it an injury from which I can recover? I am now only running three to four miles a week. I miss running and would love to run again. Please help! Best regards--Angie

Angie,

You have fallen victim to the “terrible too’s”: too much, too soon, too fast, too enthusiastically. The 130 percent increase in volume over two weeks probably did you in, as you have already figured out. In rehab of an injury, there are several key principles, the first being “correct diagnosis,” which you presumably have. A second is to control the pain. Once you have the pain under control, the modalities like ultrasound and ice add little to the outcome, so you can probably do most of this on your own (although in an ideal world you would have a physical therapist to guide you through the entire rehab). A third is to allow time for the injury to heal and avoid stresses that reinjure the tissue, which commonly takes a minimum of 12 weeks for tendon injuries. For most injuries like yours, a tincture of time will heal the tissue if you let it be.A fourth is to strengthen the core muscles that support your activity, so core strengthening activities that do not cause pain will be beneficial in the long run. Michael Fredericson has a good review article that you may find helpful. Yoga and Pilates training are other activities that will help with core strength.

The healing of tendinosis is accelerated by eccentric loading of the muscle (lengthening the muscle against resistance, often called “negatives”) to stress the tendon and induce the molecular changes required to rebuild the tissue. Most of this work has been done on the Achilles tendon, but I think there is a “class effect” that transfers to other tendons. You can find many hamstring strengthening programs on the web by searching “eccentric hamstring strengthening exercises;” you can many of thses at home. The eccentric exercises that will induce healing will also cause some pain and this may be a necessary part of the process. It also breaks the rule of home rehab “if it hurts, don’t do it.” Two exercises you can do are the squat and the Nordic hamstring curl. The squat is relatively simple and is done using a counter or sturdy piece of furniture for support. Use the counter for “light” support by standing in a position that allows you to do a full squat and use the counter to allow you to stay upright and not fall backwards. With your weight on your heels, begin to squat slowly down to 90 degrees (sitting position) while keeping your lower leg in the vertical position. Hold this position for a few seconds and then return to a full stand. Repeat this maneuver, but stop when you feel a burn in your butt and hamstrings. Gradually increase the number in each set to 15 to 25. When it gets too easy, you can increase to two or three sets or add weight with a backpack or a weight belt.

The Nordic hamstring curl is a little hard for me to describe but you can find it on youtube or by searching the web. It is a pretty advanced exercise and probably best done with a partner. This exercise is used in hamstring strain reduction programs and is easier for athletes who are younger than I am. A partner can help ease you down and increase your safety as you begin to work with this exercise.

As you work back into running, you might consider starting with long walks and progressing into a walk-run pattern to transition into full running (walk a block, run a block, walk a block, run two blocks, etc). Gradual increases in training volume and intensity will serve you and others well in the future.

I hope this helps.

Cheers,Bill

PS: Happy New Year to all and my sincere thanks to all who have contributed their thoughts to the questions and my answers over the past year. You have enriched the site and I appreciate it (as do other readers, I hope).

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